Who says bipartisan good feeling is dead? The big question hanging over health care reform right now is whether House Speaker Nancy Pelosi can get enough Democrats to vote for the Senate bill and an accompanying set of amendments that would move through the budget reconciliation process. Rather than make Pelosi and her lieutenants go to the trouble of counting all those votes, Republican House Whip Eric Cantor has generously done the work for her.

When Senators like Bernie Sanders or Sherrod Brown say Democrats need to finalize health care reform through the budget reconciliation process because of Republican obstructionism, that doesn't mean much.

When Senators Evan Bayh, Mary Landrieu, and Ben Nelson say their more liberal colleagues may be right, that means a lot.

Via Politico's Carrie Budoff Brown, here's Bayh:

I'm a longtime, enthusiastic fan of the public option. And I am really nervous about its latest rise from the grave.

In the last week and a half, Obama has rediscovered his voice on health care--telling audiences he is determined to achieve comprehensive reform, not some piecemeal version, and that he is willing to fight for it. And, administration officials say, the sentiments are genuine. Obama has instructed his staff not to abandon the pursuit of a full reform package, even though, it seems, that's what some advisers would prefer--and even though the Democrats no longer have the sixty votes necessary to break Republican filibusters in the Senate.

But rhetoric alone won't get the job done. House Speaker Nancy Pelosi has said her chamber won't vote for the Senate bill, as written, until the Senate passes modifications to that bill--something the Senate would have to do through the budget reconciliation process, in which Republicans couldn't block a vote from taking place. The modifications the House has in mind include more money for affordability protections and the elimination of a tax on expensive health benefits.

Senate Majority Leader Harry Reid, naturally, wants the House to vote for the full Senate bill first. And while he's said he thinks amending the bill in reconciliation makes sense, he wants the bill to be as small--and easy to pass--as possible. He also wants to keep the benefits tax, or some version of it.

In both cases, the leaders are basing their positions in part on what their caucus members are saying to them. Most progressives don't like the benefits tax. Most moderates don't like the alternatives--some combination of taxes on the rich and cuts to industry--and don't like the high price tag in general. Members of all ideologies are worried that passing a bill in reconciliation would drag out this politically debilitating debate longer--while giving critics more reason to think the bill is full of unsavory backroom deals.

The position of the two leadership groups isn't surprising. It's exactly the sort of posturing you’d expect in a House-Senate negotiation--and, if it were happening four or five months ago, the Democrats could afford to let it play out on its own. But there’s no time for that now. While giving health reform a small break from the spotlight is probably healthy, just letting the negotiations drag out will only disappoint supporters while antagonizing the opposition--all while the attention of members begins to wander.

Nor is it clear the two houses are even capable of reaching an agreement on their own. If members of the House were rational, they would pass the Senate bill, as written, simply because it'd be such a huge achievement--one that would make life better for literally tens of millions of Americans. And, if members of the Senate were rational, they would sign off on at least some of the House’s requested fixes without a fuss, because they were about to agree on them anyway--after the last round of negotiations, before Massachusetts--and because most of the changes make the bill better.

Indeed, there's a pretty obvious deal that ought to work for both sides, even now:

If I had to guess as I write this, I'd say no. But the trendlines for the Fed chairman aren't moving in the right direction. Today's Wall Street Journal had a piece noting that the Fed chairman was headed toward a closer than expected vote in the Senate next week, with Dems Byron Dorgan and Jeff Merkley joining Bernie Sanders, the Senate's chief Bernanke-hater on the left, as opponents of a second term.

WASHINGTON--Punditry in the nation's capital has its own rhythms, and one common practice involves almost everyone beating up on the same politician at the same time.

Such assaults are rarely about ideology, though I have found that liberals or Democrats are often the object of these sustained attacks, perhaps because journalists are overly sensitive to charges of liberal bias. There's nothing like hitting a Democrat hard to "prove" impartiality.

The U.S. Senate has voted to pass the most ambitious piece of domestic legislation in a generation--a bill that will extend insurance coverage to tens of million Americans, strengthen insurance for many more, and start refashioning American medicine so that it is more efficient.

The vote took place a little after 7 a.m., after brief speeches by the two party leaders, Harry Reid and Mitch McConnell. The final count was a 60 to 39, with every Democrat voting "aye" and every Republican in attendance voting "no."

Vice President Joe Biden presided over the session and, on the floor, members seemed aware of the moment's historical import. The ailing Robert Byrd, who had to be wheeled in to the chamber for each of this week's four votes, reportedly shouted "for my friend Ted Kennedy, aye." Bernie Sanders, the Senate's most liberal member, cast the final vote with a loud, unmistakable "yes." When the voting was over, Democrats broke out into applause.

Jacob S. Hacker is the Stanley B. Resor Professor of Political Science at Yale University. An expert on the politics of U.S. health and social policy, he is author, coauthor, or editor of numerous books and articles, both scholarly and popular, including The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream (2006; paperback, January 2008) and Health At Risk: America’s Ailing Health System and How to Heal It (2008).

As the Senate debates the health care bill put together by Majority Leader Reid, the scramble is on to come up with a new compromise regarding the public option--the public health insurance plan modeled after Medicare that will be offered within the new health insurance exchange to Americans who lack workplace health insurance (and to workers in small firms that decide to buy coverage through the exchange).

The goal of the current effort is simple: to get sixty votes to overcome a filibuster and pass a bill. Four of the sixty Senators who caucus with the Democrats have expressed, with varying degrees of certainty and specificity, that they don’t like the public option in the current bill. So the search is on for a compromise, any compromise, that will bring on these four, or allow one or two of them to be bypassed by picking up the support of Republican senators Olympia Snowe or Sue Collins.

The public option in the Senate bill, it should be emphasized, is a compromise of a compromise already. The first compromise was to have the public plan negotiate its rates directly with providers, rather than set them based on Medicare’s rates. This compromise meant that the Congressional Budget Office was unlikely to score the public plan as producing the huge savings that it projected for a plan that used Medicare-based rates. Whether CBO was right in discounting the negotiated-rate plan’s savings is another matter--as I have written on this site, it’s likely underestimating the cost-containment potential--but the CBO’s numbers rule on Capitol Hill.

The second compromise was to allow states that did not want to have the public plan operating within their borders to “opt out” with the passage of a state law. How many states will take advantage of this option is unclear, but it’s certain to reduce the impact of the public plan even further. Indeed, the CBO is now projecting—again, pessimistically in my view--that only a few million Americans will enroll in the public plan. Yet none of this has apparently appeased the handful of hold-outs. Emboldened by the White House’s lack of clarity and pressure on the issue, they are digging in their heels and spewing false claims about the public plan (for example, that it’s a budget buster when there are no special government subsidies for it and the CBO projects it will exert downward pressure on private premiums, thus lowering the price tag of reform). Hence the new push to find some kind of middle road.

The problem is that the “middle-ground” ideas that are currently flying around aren’t in the middle at all.

The ritual is becoming familiar. Health care reform passes a major political hurdle. And progressives don’t know whether to laugh or cry.

Last time, the occasion was a vote in the House of Representatives. Health care reform passed by the slimmest of margins, but not before conservative Democrats had extracted a major concession on abortion rights.

This time, it was a vote in the Senate--not on whether to pass a bill, but whether to begin debating one. This measure, too, passed by the slimmest of margins, but not before conservative Democrats and one notorious independent made clear they were prepared to shut things down later if legislation includes a public insurance option.

It’s no fun to watch this unfold. And yet this is the exactly the sort of drama you should expect for the next few weeks, as the Senate deliberations play out.

The bill Majority Leader Harry Reid introduced last week is not everything it could be--not by a long shot. And progressives will try their best to improve it. But the real battle will be an ongoing rearguard action, to fend off changes from the right--amendments that, in many cases, Republicans will support even though they have no intention of voting for the final bill. Abortion. Immigration. The mandates, for individuals and employers. You name it.

For progressives, victories are more likely to come in the form of ground not conceded than ground gained. Every day that legislation doesn’t get worse is a day to cherish.

That may not sound like much to celebrate. But to get a bit of perspective, glance over to the other ideological corner--where the right, and many of its kindred special interests, are going absolutely crazy. To some extent, they are reacting merely to the possibility that President Obama and his allies will get a political victory. But they are also reacting to the fact that health care reform, even in this highly compromised form, will have an impact.

The health care debate moves forward. On the motion to proceed, all the Democrats plus independents Joe Lieberman and Bernie Sanders voted aye. All of the Republicans present voted nay. The final count was 60 to 39. (Republican George Voinovich was back in Ohio.)

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

Have you ever been in an alley fight with three muggers while your sanctimonious non-helping cousin berates your poor fighting skills from a nearby window? Me neither. I feel like I have, though, listening to the shadenfreude coming from some single-payer advocates on the sidelines of the current health reform debate.

This morning’s New York Times provides a prime example, in a short interview with Dr. David Himmelstein of Physicians for a National Health Plan. He and the group he co-founded deserve credit for their long advocacy of a single-payer plan. They deserve less credit for their unhelpful and sometimes inaccurate stance in this critical moment of the fight for both a huge progressive reform and the Obama presidency.

This morning, Himmelstein was asked about the critical problem of medical bankruptcy, a subject to which he has contributed valuable research.

A reporter asked: "Would any of the plans under discussion on Capital Hill reduce the rate of medical bankruptcies?"

Himmelstein responded: "Only the single-payer plan sponsored by Representative John Conyers, Jr. and Senator Bernie Sanders. The others pretty clearly do little or nothing for medical bankruptcy." [italics added].

Before further comment, I should say that I see considerable merit in the single-payer system Himmelstein desires. Certainly from a public health perspective, single-payer would be vastly preferable to our current system. Give me ten more progressive senators, and we’d be having a different conversation right now. In the world we actually live in, we are in a tough fight to pass imperfect, but quite valuable bills that would do a lot of good.

For all their imperfections, the bills now under debate could have a particular impact on one problem: medical bankruptcy. To see why, consider the predicament of a family of four earning $55,000 per year.